Assistive Robotics for Upper Limb Physical Rehabilitation:A Systematic Review and Future Prospects

Physical assistive robotics are oriented to support and improve functional capacities of people.In physical rehabilitation,robots are indeed useful for functional recovery of affected limb.However,there are still open questions related to technological aspects.This work presents a systematic review of upper limb rehabilitation robotics in order to analyze and establish technological challenges and future directions in this area.A bibliometric analysis was performed for the systematic literature review.Literature from the last six years,conducted between August 2020 and May 2021,was reviewed.The methodology for the literature search and a bibliometric analysis of the metadata are presented.After a preliminary search resulted in 820 articles,a total of 66 articles were included.A concurrency network and bibliographic analysis were provided.And an analysis of occurrences,taxonomy,and rehabilitation robotics reported in the literature is presented.This review aims to provide to the scientific community an overview of the state of the art in assistive robotics for upper limb physical rehabilitation.The literature analysis allows access to a gap of unexplored options to define the technological prospects applied to upper limb physical rehabilitation robotics.

Effectiveness of negative pressure wound therapy in complex surgical treatment of necrotizing fasciitis of the upper limb

BACKGROUND Necrotizing fasciitis(NF)of the upper extremities is a severe surgical pathology,and the incidence of this disease has been steadily increasing in recent decades.Surgical treatment is accompanied by the formation of extensive wounds,which can be treated with significant difficulties.In recent years,negative pressure wound therapy(NPWT)has proven to be highly effective.It is also promising for the treatment of NF.AIM To explore the effectiveness of NPWT in the treatment of NF of the upper extremities.METHODS The results of the treatment of 36 patients with NF of the upper extremities in two groups(NPWT group and control group;2022−2023)were retrospectively analyzed.In the NPWT group,the NPWT method(120 mmHg;constant mode)was used after surgical treatment.The number of vacuum-assisted dressings in patients ranged from 1 to 3,depending on the dynamics of the wound process.The duration of fixation of one bandage was up to 2−3 d.In the control group,conventional methods of local wound treatment were used.The following indicators were analyzed:The treatment delay,the prevalence of inflammation,the microbial landscape,the number of debridements,the duration of wound preparation for surgical closure,and the nature of skin plastic surgery.RESULTS Most patients experienced a significant treatment delay[4 d,interquartile range(IQR):2–7 d],which led to the spread of the pathological process to the forearm and shoulder.The most common pathogens were Staphylococcus aureus(14;38.9%)and Streptococcus pyogenes(22;61.1%).The average number of debridements per patient was 5(IQR:3–7),with no difference between groups.The average time to prepare wounds for surgical closure was 11±4 d in the NPWT group and 29±10 d(P=0.00001)in the control group.In the NPWT group,the wounds were more often closed with local tissues(15;83.3%),and in the control group,split-thickness skin grafts were more often used(4;50%).CONCLUSION The predominant isolation of Staphylococcus aureus and/or Streptococcus pyogenes from the lesions allowed us to classify these patients as NF type II.Multiple debridement procedures have become a feature of this disease treatment.The use of NPWT has significantly reduced the time required to prepare wounds for surgical closure.Early closure of wounds allows for more frequent use of local tissue repair,which ensures better results.NPWT is a highly effective way to prepare wounds for early surgical closure in patients with upper extremity NF.

Analysis of the Effect of Limb Rehabilitation Therapy Combined with Transcranial Magnetic Stimulation Therapy on Muscle Activity in Patients with Upper Limb Dysfunction After Cerebral Infarction

Objective:To analyze the effect of limb rehabilitation therapy combined with transcranial magnetic stimulation therapy on muscle activity in patients with upper limb dysfunction after cerebral infarction(CI).Methods:320 patients with upper limb dysfunction after CI were selected,all of whom were treated in our hospital between June 2021 and June 2023.They were randomly grouped according to the lottery method into the control group(limb rehabilitation therapy,160 cases)and the intervention group(transcranial magnetic stimulation therapy+limb rehabilitation therapy,160 cases).The upper limb function scores,neuro-electrophysiological indicators,daily living ability scores,and quality of life scores of the two groups were compared.Results:Compared with the control group,upper limb function scores and daily living ability scores in the intervention group were higher after treatment,and the neuro-electrophysiological indicators of the intervention group were lower after treatment(P<0.05).Conclusion:Transcranial magnetic stimulation therapy combined with limb rehabilitation therapy has significant effects in patients with upper limb dysfunction after CI and is worthy of promotion and application.

Analysis of the Effect of Transcutaneous Electrical Stimulation of Acupoints Combined with Rehabilitation Training in The Treatment of Upper Limb Dysfunction After Stroke

Objective:To analyze the effect of combining transcutaneous electrical acupoint stimulation(TEAS)with rehabilitation training in patients with upper limb dysfunction after stroke(ULDAS).Methods:A total of 130 ULDAS patients who were hospitalized and rehabilitated in Wuxi Xinwu District Rehabilitation Hospital from May 2021 to May 2023 were selected and randomly divided into Group A(65 cases,rehabilitation training)and Group B(65 cases,rehabilitation training+TEAS).The effects of the two groups were compared.Results:After treatment,the upper limb functional indexes of Group B were better than those of Group A(P<0.05).The rate of muscle tone grades 0-4 in Group B was higher than those of Group A(P<0.05).Conclusion:The function of upper limbs and muscle strength of ULDAS patients improved by combining TEAS with rehabilitation training.

Major ozonated autohemotherapy promotes the recovery of upper limb motor function in patients with acute cerebral infarction

Major ozonated autohemotherapy is classically used in treating ischemic disorder of the lower limbs In the present study, we performed major ozonated autohemotherapy treatment in patients with acute cerebral infarction, and assessed outcomes according to the U.S. National Institutes of Health Stroke Score, Modified Rankin Scale, and transcranial magnetic stimulation motor-evoked potential. Compared with the control group, the clinical total effective rate and the cortical potential rise rate of the upper limbs were significantly higher, the central motor conduction time of upper limb was significantly shorter, and the upper limb motor-evoked potential amplitude was significantly increased, in the ozone group. In the ozone group, the National Institutes of Health Stroke Score was positively correlated with the central motor conduction time and the motor-evoked potential amplitude of the upper limb. Central motor conduction time and motor-evoked potential amplitude of the upper limb may be effective indicators of motor-evoked potentials to assess upper limb motor function in cerebral infarct patients. Furthermore, major ozonated autohemotherapy may promote motor function recovery of the upper limb in patients with acute cerebral infarction.

ACUPUNCTURE TREATMENT OF 280 CASES OF BULBAR PARALYSIS OF UPPER MOTOR NEURONS

The hulbar paralysis of upper rnotor neurons is a common seniIe disease. ln recentycars. we select Lianquan (CV 23 ) as a chief point in comhination with Jinjin (EX-HN l2 ). Yuye(FX-HN 13 ) and Zhaohai (KI 6 ) and employ uniform reinforcing-reducing manipuIation to treat 280patients. The results show that a total effectivc rate is 55. 71％. The possible mechanisms are dis-cussed preliminarily in thc present paper.

Botulinum toxin type A plus rehabilitative training for improving the motor function of the upper limbs and activities of daily life in patients with stroke and brain injury

BACKGROUND:Botulinum toxin type A(BTX-A)is mostly to be used to treat various diseases of motor disorders,whereas its effect on muscle spasm after stroke and brain injury needs further observation.OBJECTIVE:To observe the effect of BTX-A plus rehabilitative training on treating muscle spasm after stroke and brain injury.DESIGN:A randomized controlled observation.SETTINGS:Department of Rehabilitation,Department of Neurology and Department of Neurosurgery,the Second Hospital of Hebei Medical University.PARTICIPANTS:Sixty inpatients with brain injury and stroke were selected from the Department of Rehabilitation,Department of Neurology and Department of Neurosurgery,the Second Hospital of Hebei Medical University from January 2001 to August 2006.They were all confirmed by CT and MRI,and had obvious increase of spastic muscle strength in upper limbs,their Ashworth grades were grade 2 or above.The patients were randomly divided into treatment group(n=30)and control group(n=30).METHODS:①Patients in the treatment group undertook comprehensive rehabilitative trainings,and they were administrated with domestic BTX-A,which was provided by Lanzhou Institute of Biological Products,Ministry of Health(S10970037),and the muscles of flexion spasm were selected for upper limbs,20-25 IU for each site.②Patients in the treatment group were assessed before injection and at 1 and 2 weeks,1 and 3 months after injection respectively,and those in the control group were assessed at corresponding time points.The recovery of muscle spasm was assessed by modified Ashworth scale(MAS,grade 0-Ⅳ;Grade 0 for without increase of muscle strength;GradeⅣfor rigidity at passive flexion and extension);The recovery of motor function of the upper limbs was evaluated with Fugl-Meyer Assessment(FMA,total score was 226 points,including 100 for exercise,14 for balance,24 for sense,44 for joint motion,44 for pain and 66 for upper limb);The ADL were evaluated with Barthel index,the total score was 100 points,60 for mild dysfunction,60-41 for moderate dysfunction,<40 for severe dysfunction).MAIN OUTCOME MEASURES:Changes of MAS grade,FMA scores and Barthel index before and after BTX-A injection.RESULTS:All the 60 patients with brain injury and stroke were involved in the analysis of results.①FMA scores of upper limbs:The FMA score in the treatment group at 2 weeks after treatment was higher than that before treatment[(14.98±10.14),(13.10±9.28)points,P<0.05],whereas there was no significant difference at corresponding time point in the control group.The FMA scores at 1 and 3 months in the treatment group[(23.36±10.69),(35.36±11.36)points]were higher than those in the control group[(20.55±10.22),(30.33±10.96)points,P<0.01].②MAS grades of upper limbs:There were obviously fewer cases of gradeⅢin MAS at 2 weeks after treatment than before treatment in the treatment group(0,9 cases,P<0.05),whereas there was no obvious difference in the control group.There were obviously fewer cases of gradeⅢin MAS at 2 weeks and 1 month after treatment in the treatment group(0,0 case)than the control group(5,2 cases,P<0.01).③Barthel index of upper limbs:The Barthel index at 2 weeks after treatment was higher than that before treatment in the treatment group[(30.36±22.25),(28.22±26.21)points,P<0.05],whereas there was no significant difference in the control group.The Barthel indexes at 1 and 3 months after treatment in the treatment group were obviously higher than those in the control group[(20.55±10.22),(30.33±10.96)points,P<0.01].CONCLUSION:BTX-A has obvious efficacy on decreasing muscle tension after stroke and brain injury,and relieving muscle spasm;Meanwhile,the combination with rehabilitative training can effectively ameliorate the motor function of upper limbs and ADL of the patients.

CLINICAL OBSERVATION ON 617 CASES OF PEDIATRCIC SYNDROME OF ATROPHIC PARALYSIS OF THE LIMBS TREATED WITH ACUPUNCTURE

The syndrome of atrophic paralysis of thelimbs refers to a group of diseases characterizedby atrophy and weakness of the limbs.Patientswith this syndrome are unable to move theirlimbs voluntarily,which may be accompaniedby numbness and muscular atrophy.This diseaseis more commonly seen in the lower limbs.

Effect of meridian sinew row needling combined with dermal needling on spasticity of post-stroke patients with upper limb hemiparalysis: a multi-center randomized controlled trial

Objective To explore the effect of meridian sinew row needling combined with dermal needling on spasticity of post-stroke patients with upper limb hemiparalysis. Methods Four hundred and eighty-eight cases of post-stroke patients with upper limb spasticity were randomly divided into two groups at the ratio of 1： 1, the group of meridian sinew row needling combined with dermal needling （group A, 244 cases） and western medication group （group B, 244 cases）. Coupled with rehabilitation, the patients in the group A were given meridian sinew row needling combined with dermal needling where five shu points were specifically selected, and three yang meridians of the hand were treated with acupuncture with muscle region, and three yin meridians of the hand were treated with dermal needles; the patients in the group B was treated with conventional western medication with piracetam injection and cerebroprotein hydrolysate included. Clinical efficacy was evaluated among patients in the two groups after three weeks of continuous treatment, and upper limb spasticity and motor functions were observed through modified Asworth Scale and FugI-Meyer Assessment Scale （FMA） before and after treatment. Results For Asworth Scale, group A was significantly superior to group B （3.04 ± 1.29 vs 3.88 ± 1.54, P〈0.05）; for FMA scale, group A was also significantly superior to group B （48.67± 15.64 vs 42.96±14.72, P〈0.05）; mitigations of motor status of upper limb joints in group A, such as remission of shoulder adduction （90.5%）, pronation of forearm （70.7%）, elbow joint flexion （73.1%）, wrist joint flexion （80.9%） and finger flexion （88.1%）, were superior to those of group B （70.0%, 60.0%, 61.9%, 57.4%, 63.2%, all P〈0.05）. Conclusion Good clinical efficacy of the treatment with combined with dermal needling on spasticity of post-stroke patients with upper limb hemiparalysis is achieved.

Evaluation of the Curative Effect of "Xingnao Kaiqiao" Acupuncture Based on Brunnstrom Staging on Upper Limb and Hand Motor Function in the Recovery Period after Stroke

Objective: To observe the effects of Xingnao Kaiqiao acupuncture(醒脑开窍针) on the motor function of upper limb and hand in the recovery period after stroke. Methods: Seventy-six cases of hemiplegia patients with ischemic stroke were divided into the treatment group and the control group(n=38 in each). Based on the Brunnstrom's stage of Xingnao Kaiqiao acupuncture combined with rehabilitation training was used in the treatment group, and the control group was given rehabilitation training. FuglMeyer Assessment of the upper extremity(FMA-UE), Action Research Arm Test(ARAT) and Simple Test for Evaluating hand Function(STEF) were adopted separately to compare scores before treatment and 8 weeks after treatment. Results: The difference was not statistically significant in the two groups of patients for comparison of FMA-UE, ARAT and STEF scores before treatment(P>0.05). The difference was statistically significant in the two groups of score comparison of FMA-UE, ARAT and STEF after treatment(P<0.05). Conclusion: The Xingnao Kaiqiao acupuncture has its unique advantages in improving recovery of motor function of upper limb and hand in recovery period after stroke.

Fire-needle acupuncture for upper limb spastic paralysis after stroke:Study protocol for a randomized controlled trial

Background: Fire-needle acupuncture, an important kind of acupuncture therapy, has been clinically used to treat upper limb spastic paralysis(ULSP) after stroke. Clinical experience has indicated that fire-needle acupuncture treatment takes less time, requires fewer visits, and has more rapid results and fewer side effects compared to chemical medicine alternatives. This study will evaluate the effects of fire-needle acupuncture for ULSP in the context of standardized clinical research and provide high-quality data to inform clinical procedures and future study design.Methods/Design: A randomized controlled trial will be carried out to evaluate the effects of fire-needle acupuncture therapy in patients with ULSP from stroke. ULSP patients(n = 120) will be recruited at Changhai Hospital in Shanghai, China. Patients will be randomly divided into three groups, including fire-needle acupuncture group(FAG), filiform-needle acupuncture group(FFAG) and rehabilitation treatment group(RTG). During the 3-week treatment, the FAG will be treated every two days, while FFAG and RTG will be treated 5 d in a row and then rest for 2 d. The Simplified Fugl-Meyer Motor Function Scale and Modified Ashworth Scale will be used as the primary outcome measures. Statistical analysis will be conducted by an independent statistician.Discussion: Through this study, the utility of fire-needle acupuncture in treating ULSP after stroke will be tested, and some specific claims of fire-needle acupuncture therapy will be evaluated, such as relieving spasm and muscular tension, improving activities of daily living, rapidity of response and less frequency of treatment compared with other treatments.

Pretreatment with a modified St.Thomas'solution in patients with severe upper limb injuries:Four case reports

BACKGROUND This study aims to describe the application of a modified St.Thomas'solution in patients with severe limb injuries.CASE SUMMARY Four patients who sustained a high-energy trauma and underwent complete upper limb amputation were pretreated with a modified St.Thomas'solution before upper limb replantation.After the perfusion solution stopped flowing from the blood vessel,the amputated upper limb amputation was replanted.The patients were instructed to perform functional rehabilitation training after the operation.All 4 patients were followed up for 5 years.All the severed upper limbs survived.Routine re-examination after the operation showed that the function of the affected limb was restored.All the patients were satisfied with the sensory and functional recovery of the affected limb.CONCLUSION The modified St.Thomas'solution can effectively improve the success rate of limb salvage surgery and the recovery of limb function in patients with a severe limb injury.

Leap Motion-based virtual reality training for improving motor functional recovery of upper limbs and neural reorganization in subacute stroke patients

Virtual reality is nowadays used to facilitate motor recovery in stroke patients. Most virtual reality studies have involved chronic stroke patients; however, brain plasticity remains good in acute and subacute patients. Most virtual reality systems are only applicable to the proximal upper limbs （arms） because of the limitations of their capture systems. Nevertheless, the functional recovery of an affected hand is most difficult in the case of hemiparesis rehabilitation after a stroke. The recently developed Leap Motion controller can track the fine movements of both hands and fingers. Therefore, the present study explored the effects of a Leap Motion-based virtual reality system on subacute stroke. Twenty-six subacute stroke patients were assigned to an experimental group that received virtual reality training along with conventional occupational rehabilitation, and a control group that only received conventional rehabilitation. The Wolf motor func- tion test （WMFT） was used to assess the motor function of the affected upper limb; functional magnetic resonance imaging was used to measure the cortical activation. After four weeks of treatment, the motor functions of the affected upper limbs were significantly improved in all the patients, with the improvement in the experimental group being significantly better than in the control group. The action perfor- mance time in the WMFT significantly decreased in the experimental group. Furthermore, the activation intensity and the laterality index of the contralateral primary sensorimotor cortex increased in both the experimental and control groups. These results confirmed that Leap Motion-based virtual reality training was a promising and feasible supplementary rehabilitation intervention, could facilitate the recovery of motor functions in subacute stroke patients. The study has been registered in the Chinese Clinical Trial Registry （registration number： ChiCTR-OCH- 12002238）.

Mechanism of Kinect-based virtual reality training for motor functional recovery of upper limbs after subacute stroke

The Kinect-based virtual reality system for the Xbox 360 enables users to control and interact with the game console without the need to touch a game controller, and provides rehabilitation training for stroke patients with lower limb dysfunctions. However, the underlying mechanism remains un- clear. In this study, 18 healthy subjects and five patients after subacute stroke were included. The five patients were scanned using functional MRI prior to training, 3 weeks after training and at a 12-week follow-up, and then compared with healthy subjects. The FugI-Meyer Assessment and Wolf Motor Function Test scores of the hemiplegic upper limbs of stroke patients were significantly increased 3 weeks after training and at the 12-week follow-up. Functional MRI results showed that contralateral primary sensorimotor cortex was activated after Kinect-based virtual reality training in the stroke patients compared with the healthy subjects. Contralateral primary sensorimotor cortex, the bilateral supplementary motor area and the ipsilateral cerebellum were also activated during hand-clenching in all 18 healthy subjects. Our findings indicate that Kinect-based virtual reality training could promote the recovery of upper limb motor function in subacute stroke patients, and brain reorganization by Kinect-based virtual reality training may be linked to the contralateral sen- sorimotor cortex.

Development of a Wearable Upper Limb Rehabilitation Robot Based on Reinforced Soft Pneumatic Actuators

Dyskinesia of the upper limbs caused by stroke,sports injury,or trafc accidents limits the ability to perform the activities of daily living.Besides the necessary medical treatment,correct and scientifc rehabilitation training for the injured joint is an important auxiliary means during the treatment of the efected upper limb.Conventional upperlimb rehabilitation robots have some disadvantages,such as a complex structure,poor compliance,high cost,and poor portability.In this study,a novel soft wearable upper limb rehabilitation robot(SWULRR)with reinforced soft pneumatic actuators(RSPAs)that can withstand high pressure and featuring excellent loading characteristics was developed.Driven by RSPAs,this portable SWULRR can perform rehabilitation training of the wrist and elbow joints.In this study,the kinematics of an SWULRR were analyzed,and the force and motion characteristics of RSPA were studied experimentally.The results provide a reference for the development and application of wearable upper limb rehabilitation robots.An experimental study on the rotation angle of the wrist and the pressure of the RSPA was conducted to test the efect of the rehabilitation training and verify the rationality of the theoretical model.The process of wrist rehabilitation training was tested and evaluated,indicating that SWULRR with RSPAs will enhance the fexibility,comfort,and safety of rehabilitation training.This work is expected to promote the development of wearable upper-limb rehabilitation robots based on modular reinforced soft pneumatic actuators.

Application of the Somatosensory Interaction Technology Combined with Virtual Reality Technology on Upper Limbs Function in Cerebrovascular Disease Patients

Objective: To explore the effects of the somatosensory interaction technology combined with virtual reality technology on upper limbs function and activities of daily living (ADL) in cerebrovascular disease patients. Methods: Form January, 2019 to December, 2019, 80 cerebrovascular disease patients were recruited, and had been divided into control group (n = 40) and observation group (n = 40), randomly. The control groups received conventional rehabilitation treatment, for 40 minutes per day, while observation group received conventional rehabilitation treatment, for 20 minutes per day, and virtual reality technology treatment, 20 minutes per day, 5 days a week for 4 weeks. Wolf Motor Function Test (WMFT), Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and modified Barthel index (MBI) were used to assess the motor function of the upper limbs and ADL before and after treatment. Results: Before treatment, the scores of WMFT, FMA-UE and MBI were no significant difference between two groups (P > 0.05). The scores improved in both groups after treatment (P < 0.01), and were higher in the observation group than in the control group (P < 0.05). Conclusion: The somatosensory interaction technology combined with virtual reality technology could facilitate to improve the upper limbs function and ADL in cerebrovascular disease patients.

Effectiveness of six-step complex decongestive therapy for treating upper limb lymphedema after breast cancer surgery

BACKGROUND Complex decongestive therapy(CDT)is currently recommended as the standard treatment for lymphedema.CDT is a four-step detumescence therapy that can effectively treat upper limb lymphedema after breast cancer surgery,and is considered non-invasive,painless and without side effects.AIM To determine the effectiveness of a six-step CDT involving a foam granule bandage for the treatment of upper extremity lymphedema pressure after breast cancer surgical intervention.METHODS The study included 100 patients with upper extremity lymphedema after breast cancer surgery.The surgical methods were mastectomy plus axillary lymph node dissection and breast preservation plus sentinel lymph node biopsy.The study population was further divided into the experimental group and control group with 50 cases in each group.The control group was given conventional CDT(four-step method),which included skin care,freehand lymphatic drainage,foam granule pressurized bandage,and functional exercise.In the experimental group,a six-step CDT method was applied that involved a foam particle bandage combined with air wave pressure therapy in addition to the four steps of conventional CDT.Patients in both groups were given one course of treatment daily(20 times),and the changes in body moisture and subjective symptoms were measured before and after treatment,preoperatively and 20 times after treatment.RESULTS No statistically significant differences in 50-Hz bioelectrical impedance and extracellular moisture ratio were observed between the two groups before treatment,suggesting comparability of the baseline data.After treatment,the 50-Hz bioelectrical impedance of the experimental group was significantly higher than that in the control group,and the extracellular moisture ratio was significantly lower than that in the control group.A comparison of the differences between the two groups before and after treatment indicated that the treatment effect in the experimental group was better than that in the control group.After 20 treatments,according to subjective evaluations,the tightness and swelling of the limbs in the experimental group were significantly reduced as compared with those in the control group.CONCLUSION The six-step CDT method can effectively reduce lymphedema,promote lymphatic circulation,and alleviate the subjective symptoms of patients,and thereby improve the quality of life and treatment compliance among patients.

Effect of Physical Intervention on Preventing Upper Limb Venous Thrombosis of Patients with PICC: A Systematic Review and Meta-Analysis of Randomized Trials

Objective: To evaluate the effect of physical methods on the prevention of venous thrombosis in patients with peripherally inserted central catheter (PICC). Methods: Randomized controlled trials meeting the inclusion and exclusion criteria were retrieved from the following databases: Cochrane library, Pubmed, EMbase, Web of science, Ovid, CBM, CNKI, Wanfang, VIP, then Review Manage (RevMan) 5.3 software was used for data analysis. Results: A total of 24 RCTs including 3496 patients were analyzed in the study. The results of meta-analysis showed that various forms of upper limb movements could effectively decrease the incidence of venous thrombosis in the patients with PICC [RR = 0.23, 95% CI (0.16, 0.33), P < 0.01], upper limb movements could effectively improve the mean blood flow velocity of basilic vein [MD = 1.65, 95% CI (1.19, 2.11), P < 0.01]. Conclusion: Upper limb movements can effectively decrease the incidence of phlebothrombosis and improve the mean flow velocity of basilic vein in the patients undergoing PICC. Other forms of physical prevention methods need to be further studied due to insufficient sample size.

Acute pulmonary embolism originating from upper limb venous thrombosis following breast cancer surgery:Two case reports

BACKGROUND Upper limb venous thrombosis(ULVT)is rarer than lower-extremity deep venous thrombosis,and is related to Paget-Schroetter syndrome,central venous catheterization,and malignancy.There are few reports of pulmonary embolism(PE)from upper-extremity vein thrombosis due to surgery.Herein,we report two cases of PE that originated from upper limb venous thrombosis on the surgical side in two patients undergoing modified radical mastectomy for breast cancer.These cases challenge the traditional theory that PE originate only from the lower extremities.CASE SUMMARY We describe two female patients,aged 68 and 65 years,respectively,who had undergone modified radical mastectomy for breast cancer.They did not have a central venous catheter and did not undergo preoperative neoadjuvant chemotherapy.They were transferred to the intensive care unit due to symptomatic PE on the first day after surgery.Colour Doppler ultrasound identified fresh thrombosis in their upper limb veins,which was the presumed source of the PE.They all received anticoagulation therapy,and one of them experienced bleeding that required discontinuation of the drug.Ultimately,they were discharged in stable condition.CONCLUSION ULVT as a source of PE after breast cancer surgery cannot be ignored.

Application value of sevoflurane light general anesthesia via laryngeal mask airway combined with brachial plexus block for children with upper limb fractures

Objective:To study the application value of sevoflurane light general anesthesia via laryngeal mask airway combined with brachial plexus block for children with upper limb fractures. Methods:Children who underwent upper limb fracture surgery in the First Women and Children's Hospital of Huizhou between June 2014 and April 2017 were selected as the research subjects and randomly divided into the combined group who accepted sevoflurane light general anesthesia via laryngeal mask airway combined with brachial plexus block and the control group who accepted sevoflurane light general anesthesia via laryngeal mask airway. The contents of inflammatory cytokines IL-1β, TNF-α, CRP, IL-10 and TGF-β as well as stress hormones FC, Ins, NE and E in serum were determined the same day and 3 days after operation.Results: The same day and 3 days after operation, the contents of IL-1β, TNF-α, CRP, IL-10, TGF-β, FC, Ins, NE and E in serum of combined group were significantly lower than those of control group.Conclusion: Sevoflurane light general anesthesia via laryngeal mask airway combined with brachial plexus block is more effective than sevoflurane light general anesthesia via laryngeal mask airway to suppress the inflammatory stress response in children with upper limb fracture surgery.